An Overview of Graves' Ophthalmopathy

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Graves' disease is a thyroid disorder that can cause serious eye problems as well. Some people with Graves' disease can develop a condition known as Graves' ophthalmopathy, or thyroid eye disease.

In Graves' ophthalmopathy, inflammation and swelling can affect muscles and other tissues around the eyes.

This article gives an overview of Graves' opthalmopathy, including symptoms, causes, diagnosis, and treatment.

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How the Thyroid Gland Works

Symptoms

With Graves' ophthalmopathy, inflammation affects the muscles and other tissues around your eyes. This can cause your eyeballs to bulge, which is one of the most recognizable symptoms. This symptom is also called exophthalmos, or proptosis.

Exophthalmos causes the eyes to feel achy and irritated, especially if your eyelids can't close well to protect them.

Signs and symptoms of Graves' ophthalmopathy include the following:

  • Bulging of the eyes (exophthalmos)
  • Seeing the whites of the eyes all around the pupil
  • Pressure or pain in the eyes
  • Gritty sensation in the eyes
  • Puffy eyelids
  • Red, burning eyes
  • Light sensitivity
  • Double vision
  • Reduced vision
symptoms of graves' ophthalmopathy
Illustration by Cindy Chung, Verywell

Causes

Graves' ophthalmopathy occurs in about 30% of people with Graves' disease of the thyroid. In most cases, your immune system attacks the muscles and other tissues of the eye. Inflammation causes swelling and scarring.

The cornea may be damaged by the bulging forward of the eyes. Inflamed or scarred muscles that hold the optic nerve in place may also become damaged, resulting in vision loss if left untreated.

Recap

Bulging eyes are the main symptom of Graves' ophthalmopathy. You may also feel irritation and see double vision. Symptoms are caused by the immune system attacking muscles and other tissues in the eye.

Diagnosis

If you have signs of eye problems associated with Graves' disease, you should see an ophthalmologist for a full eye exam.

Doctors will complete a physical exam by looking at the eyes for signs of irritation or signs of the eyes protruding. They will also examine the thyroid gland to see if it is enlarged.

Treatment

Most symptoms of Graves' ophthalmopathy can be treated successfully. Your ophthalmologist will help you determine treatment based on your symptoms.

Medications

To minimize eye irritation, your ophthalmologist may suggest using artificial tears several times per day. Ointments may be applied at night to prevent the eyes from drying out.

Steroids, such as prednisone, may be given to reduce swelling behind the eyes.

In 2020, the Food and Drug Administration (FDA) approved Tepezza (teprotumumab-trbw) for treating Graves' ophthalmopathy. In studies, it was shown to reduce eye protrusion by more than two millimeters in more than 70% of patients.

Recap

Medications for Graves' opthalmopathy may include artificial tears eye drops, ointments, steroids, and Tepezza (teprotumumab-trbw).

Radiation

Orbital radiotherapy, or radiation, may be considered to treat inflammation around the eyes. You receive the treatment in an outpatient setting for up to 12 visits. Studies have shown that orbital radiotherapy and steroids are more effective than using steroids alone.

Surgery

If your eyes are bulging a lot, a surgeon may perform orbital decompression surgery. This procedure involves removing the thin bones that make up the orbit of the eye so that the eyes may move back to a more normal position.

This can relieve the pressure around your eyes, which is important for maintaining pressure in your eyes as well. High eye pressure can raise the risk of developing glaucoma.

Eye muscle surgery may be performed if needed. Eyeglass prisms may be prescribed if the eye muscles are so swollen that the eyes can no longer be aligned properly.

Stop Smoking

If you smoke, quitting can help your treatment to be more effective. A study review found that smokers had worse treatment outcomes for Graves' opthalmopathy than nonsmokers. Smokers were also more likely than nonsmokers to develop thyroid eye disease.

Summary

Graves' opthalmopathy causes inflammation that affects the muscles and tissues around your eyes. It can cause your eyes to bulge. You may also have double vision and eye irritation. Your opthalmologist will suggest treatment to reduce symptoms and prevent further complications.

A Word From Verywell

Symptoms of Graves' ophthalmopathy can be successfully treated. If you have Graves' disease and are experiencing eye symptoms, check with your doctor or opthalmologist.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mcalinden C. An overview of thyroid eye disease. Eye Vis (Lond). 2014;1:9. doi:10.1186/s40662-014-0009-8

  2. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726-38. doi:10.1056/NEJMra0905750

  3. Bausch & Lomb Incorporated. Graves’ disease (graves’ ophthalmopathy)

  4. Griepentrog GJ, Garrity JA. Update on the medical treatment of Graves' ophthalmopathy. Int J Gen Med. 2009;2:263-9. doi:10.2147/ijgm.s6856

Additional Reading
  • Bartlett JD, Siret J. "Clinical Ocular Pharmacology," Chapter 27: Thyriod-Related Eye Disease, pages 699-724. Butterworth-Heinemann, 1989.